Provider Demographics
NPI:1710505060
Name:SPENCER, SETH CANNON (MD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:CANNON
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 MEETING ST
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-6582
Mailing Address - Country:US
Mailing Address - Phone:980-987-3991
Mailing Address - Fax:
Practice Address - Street 1:3800 MEETING ST
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:NC
Practice Address - Zip Code:28079-6582
Practice Address - Country:US
Practice Address - Phone:980-987-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025-00002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics